Semaglutide, the active ingredient in Ozempic, and other drugs in the same class, have revolutionized the treatment of obesity and type 2 diabetes. Currently, clinical trials suggest that the drug can treat type 1 diabetes.
The results of the trial published in NEJM evidence on June 23 suggest that semaglutide can improve blood glucose levels and cause weight loss in people with type 1.
“For 100 years, we’ve been obsessed with insulin and insulin delivery…and there’s actually no extra type 1 approved drug,” Dr. Viral Shah, a diabetes researcher at Indiana University, told Live Science. There are several add-on drugs approved for use with insulin, but Shah envisions drugs like Ozempic as a potential first-line treatment.
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He said that it makes sense to investigate those treatments because insulin resistance and fuel type 2 diabetes also have impaired release of digestive hormones that may be present in type 1.
Type 1, Type 2, and Dual Diabetes
Type 1 and type 2 diabetes are driven by very different mechanisms.
In Type 2, the cells in the pancreas that make insulin become sensitive to blood glucose and do not respond to produce insulin. Insulin usually helps to direct sugar from the bloodstream to cells, which is why this effect causes sugar to accumulate in the blood. Type 1 diabetes, on the other hand, is an autoimmune disorder in which insulin secreting cells are destroyed by your own immune system.
Related: In 1st Scientist, the scientist reversed type 1 diabetes and reprograms a person’s own fat cells
There are several medications for type 2 diabetes, focusing on driving cells to secrete more insulin, and standard treatments focused on improving the risk of glycemic control, weight loss, hypertension and cardiovascular disease through lifestyle changes. Drugs like semaglutide, known as GLP-1 agonists, control type 2 blood glucose by reducing hormones produced in the liver, which raises blood glucose levels and slowing digestion. This will make you feel fuller for longer and more fulfilling and allow more time for the pancreas to release the right amount of insulin.
However, the main way to control blood glucose in type 1 diabetes is insulin supplementation. However, type 1 diabetes patients, especially obese diabetics, are often insulin resistant, and therefore many of the same health problems as type 2 diabetes patients (e.g. nerve damage, foot ulcers, eye damage) are all due to lack of blood glucose. This condition is called “double diabetes.”
“Type 1 diabetes does not rule out the presence of type 2 diabetes,” Shah said. “People with the double diabetes phenotype may benefit from some of the currently approved drugs for type 2 diabetes.” That was the idea behind a new trial of Semaglutide, an ingredient found in the weight loss drug Ozempic and Wegovy, a type 2 diabetes drug.
The researchers recruited 72 patients with type 1 diabetes and obesity based on their BMI. Half of participants received weekly semaglutide injections and the other half placebo for 26 weeks. All participants continued to use insulin as needed during the study and monitored blood glucose levels using a continuous glucose monitor.
Patients taking semaglutide had better control of their glucose levels, staying within acceptable blood glucose levels for 70% of the time, and spending less time on hypoglycemia levels. Those who received treatment also lost at least 5% of their weight. However, no one in the outstanding group meets all three criteria.
These results support results from other recent trials that show that these drugs used for type 2 diabetes are worth exploring in patients with type 1 diabetes, said Ahmad Haider, a diabetes researcher at McGill University in Canada, was not involved in the study.
“This is an important study that adds existing evidence towards the safety and efficacy of semaglutide use in type 1, but that’s not enough,” Haider told Live Science. “We need more evidence to help these drugs be approved by regulatory agencies.”
Shah and his colleagues hope that with more clinical trials with a larger cohort of patients, the research community will gather enough evidence to approve GLP-1 by the Food and Drug Administration and add it to the American Diabetes Association’s standards of care.
“And if that happens, I think this will probably be the first non-insulin drug used by people with type 1 diabetes,” Shah said. “It’s really exciting to see that it’s moving forward.”
This article is for informational purposes only and is not intended to provide medical advice.
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